Physiotherapy vs surgery for back pain (canal stenosis)

Physiotherapy may work as well as surgery for chronic back pain

Epidemiological studies suggest most of us will have back pain at some stage in our life and whilst most conditions are manageable with simple techniques, a proportion of back conditions can be more troublesome.

Symptoms may worsen over time leading to reduced function and surgery may eventually be offered as a treatment alternative. Deciding which treatment to embark upon can be difficult as risks associated with some treatments require consideration.

Symptomatic lumbar spinal stenosis (LSS) is a back condition where the spinal canal narrows causing compression of neural structures, at times causing back and/or lower limb symptoms. If severe enough, surgery can be performed for this condition. There is also a lack of evidence for the non-surgical management of LSS.

So, what are the long term outcomes for surgery compared with physio treatment for LSS?

A recent study by Delitto et al. 2015, discussed in the media recently, compared the two treatments for chronic low back pain. Subjects were drawn from a population of surgical candidates aged 50 and over, and were only included in the trial if they were willing to receive either treatment. Statistical analysis took into account the significant number of patients in the physio group deciding to cross-over and have surgery during the course of the study. The results indicated that physio can be as effective as surgery for physical function up to 2 years following treatment.

The lack of control group in the study means we are not able to determine the individual benefit of either treatment. However, the results of this study should be considered, alongside the relative risks associated with each treatment, when deciding which management path to take.

Matt Richards in a Physiotherapist at Advance Healthcare in Bundoora.  Matt has a special interest in sub-acute and chronic Low Back Pain.  The clinic in Bundoora (located close to Thomastown, Reservoir and Mill Park) provides an evidence based Pain Management Program for chronic conditions as well as general physiotherapy